發(fā)布時間：2018-06-08 06:15

  本文選題：安全區(qū) + 血管神經(jīng)�。� 參考：《河北醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 目的:劃定國人跟骨內(nèi)外側(cè)、脛骨近端外固定針進針位置解剖學(xué)相對安全區(qū),為臨床醫(yī)師手術(shù)中安全操作提供依據(jù),減少臨床并發(fā)癥的發(fā)生。 方法:選擇4具防腐成年男性尸體,共8只下肢標本,各標本膝關(guān)節(jié)囊均完整未被破壞,踝部、足跟內(nèi)、外側(cè)深部結(jié)構(gòu)尚未解剖,足部、膝部外觀均無外傷、畸形等疾患。在每個標本足跟內(nèi)側(cè):取跟骨最內(nèi)下后點標記為“A”點,內(nèi)踝最下點標記為“B”點,足舟骨結(jié)節(jié)標記為“C”點。(Fig.1)解剖分離出跟骨內(nèi)側(cè)神經(jīng)(MCN)、足底外側(cè)神經(jīng)最后分支(MPLPN)、足底外側(cè)神經(jīng)(LPN)、足底內(nèi)側(cè)神經(jīng)(MPN)和脛后動脈(PTA)或為足底外側(cè)動脈(LPA)、足底內(nèi)側(cè)動脈(MPA)。測量AB、AC的距離(本文數(shù)據(jù)均以mm為單位,并精確到小數(shù)點后兩位),分別測量AB、AC線上各神經(jīng)血管結(jié)構(gòu)與AB、AC線交點距A點的距離。計算各神經(jīng)血管結(jié)構(gòu)與AB、AC線交點距A點的距離分別占AB、AC線的百分比,確定跟骨內(nèi)側(cè)的相對安全區(qū)。在標本足跟外側(cè):取跟骨最外下后點標記為“D”點,外踝最下點標記為“E”點,解剖出跟骨外側(cè)神經(jīng)(LCN)、腓腸神經(jīng)(SN)、小隱靜脈(SSV)主干,測量DE的距離,分別測量DE線上各神經(jīng)血管結(jié)構(gòu)與DE線交點距D點的距離。計算各神經(jīng)血管結(jié)構(gòu)與DE線交點距D點的距離占DE線的百分比,確定跟骨外側(cè)的相對安全區(qū)。再解剖脛骨近端,顯露膝關(guān)節(jié)囊在脛骨近端各方向上的最低返折線。將脛骨平臺假想為圓形表盤(正前方為0點或12點,正后方為6點),用時針點數(shù)的方向作為測量位置,依次測量、記錄各點處膝關(guān)節(jié)囊滑膜層最低返折線(即關(guān)節(jié)囊纖維層附著線水平)距對應(yīng)方位的脛骨平臺外緣距離。統(tǒng)一以右膝順時針為準,統(tǒng)計數(shù)據(jù),確定膝關(guān)節(jié)囊在脛骨近端返折線的范圍,進而確定脛骨近端經(jīng)皮穿針安全區(qū)。 結(jié)果:跟骨內(nèi)側(cè):在AB線上跟骨內(nèi)側(cè)神經(jīng)、足底外側(cè)神經(jīng)最后分支、足底外側(cè)神經(jīng)、足底內(nèi)側(cè)神經(jīng)、脛后動脈與AB線交點距A點的距離占AB線距離的百分比分別為22%、50%、55%、64%、58%。即大部分重要神經(jīng)血管結(jié)構(gòu)位于AB線前上1/2。在AC線上跟骨內(nèi)側(cè)神經(jīng)、足底外側(cè)神經(jīng)最后分支、足底外側(cè)神經(jīng)、足底內(nèi)側(cè)神經(jīng)、足底外側(cè)動脈、足底內(nèi)側(cè)動脈與AC線交點距A點的距離占AC線距離的百分比分別為14%、38%、48%、64%、41%、58%。即大部分重要神經(jīng)血管結(jié)構(gòu)位于AC線前上2/3。跟骨外側(cè):在DE線上跟骨外側(cè)神經(jīng)、腓腸神經(jīng)、小隱靜脈與DE線交點距D點的距離占DE線距離的百分比分別為20%、66%、62%。即大部分重要神經(jīng)血管結(jié)構(gòu)位于DE線前上2/5。膝關(guān)節(jié)囊:外側(cè)最低返折點約位于5點附近,平均值為10.27mm,其95%可信區(qū)間為(8.18～12.36)。內(nèi)側(cè)最低返折點約位于10點附近,平均值為5.94mm,其95%可信區(qū)間為(5.25～7.6)。 結(jié)論:在跟骨內(nèi)側(cè),AB線后1/2 AC線后1/3的區(qū)域為經(jīng)皮穿針相對安全區(qū),靠后一些更安全。跟骨外側(cè),DE線后3/5為經(jīng)皮穿針相對安全區(qū)。膝關(guān)節(jié)外側(cè)關(guān)節(jié)囊最低返折點約位于5點附近,關(guān)節(jié)面下方12.36mm以下為經(jīng)皮穿針相對安全區(qū)。膝關(guān)節(jié)內(nèi)側(cè)關(guān)節(jié)囊最低返折點位于10點附近,關(guān)節(jié)面下方7.6mm以下為經(jīng)皮穿針相對安全區(qū)。
[Abstract]:Objective: to delimit the internal lateral lateral of the calcaneus of the Chinese and the relative safety area of the needle entry position of the proximal tibial external fixation needle, so as to provide the basis for the safety operation of the clinicians and reduce the incidence of clinical complications.
Methods: 4 adult male cadavers were selected and 8 lower limbs were intact. All the specimens of the knee joint were intact. The ankle, the heel and the deep lateral structure were not dissected. The appearance of the foot and knee were all without trauma and malformation. On the inside of the heel of each specimen, the most lower point of the heel was marked "A", and the lowest point of the medial malleolus was marked as the lower point of the medial malleolus. "B" point, the scaphoid tubercle is marked as "C" point. (Fig.1) dissection of the medial calcaneal nerve (MCN), the final branch of the lateral nerve (MPLPN), the lateral nerve of the foot (LPN), the medial plantar nerve (MPN) and the posterior tibial artery (PTA) or the medial plantar artery (LPA), and the medial plantar artery (MPA). The distance between the neurovascular structure of AB and the AC line and the distance from the AB and AC line to the A point was measured respectively. The distance between the nerve vessel structure and AB, the distance between the AC line intersection point and A point was AB, the percentage of the AC line, respectively, to determine the relative safety area of the medial calcaneus. At the lateral of the heel of the specimen, the two place of the calcaneus was marked as "the most out of calcaneus." D "point, the lowest point of the outer malleolus was marked as" E "point, dissected the lateral nerve (LCN), the gastrocnemius nerve (SN) and the trunk of the small saphenous vein (SSV), measured the distance between the DE and the DE line, and measured the distance between the intersection of the neurovascular structure and the DE line at the D point respectively. The distance between the node and D point of the nodal distance between the neurovascular and DE lines accounted for the percentage of the DE line and the calcaneus was determined. The relative safety zone on the lateral side of the tibia was dissected and the lowest back fold line in the proximal tibia of the knee was revealed. The tibial plateau was assumed to be a circular dial (0 or 12 points in front of the front, 6 in the rear), and the direction of the number of clockwise points was used as the measuring position, and the minimum back folding line at the knee capsule synovial layer at each point was recorded. The level of the attachment line of the fibrous layer of the joint capsule is distance from the outer edge of the tibial plateau of the corresponding azimuth. The statistical data is used to determine the range of the knee joint capsule in the proximal tibia, and then to determine the safety area of the proximal tibial puncture needle.
Results: the medial calcaneal nerve, the last branch of the lateral nerve, the lateral nerve of the foot, the medial plantar nerve, the medial plantar nerve, the distance from the A point distance between the posterior tibial artery and the AB line at the distance A, respectively, were 22%, 50%, 55%, 64%, and 58%., that is, most of the important neurovascular structures were located on the AC line and the medial calcaneus on the AC line at the front of the AB line. The percentage of the distance between the medial plantar nerve, the medial plantar nerve, the lateral artery of the foot, the distance between the medial plantar artery and the AC line distance from the A point was 14%, 38%, 48%, 64%, 41%, and 58%., the most important neurovascular structures were located at the lateral 2/3. calcaneus on the AC line, the lateral nerve of the calcaneus on the DE line, The percentage of the distance from the distance between the small saphenous vein and the DE line at the distance from the D point to the DE line was 20%, 66%, and 62%., the most important neurovascular structures were located in the upper 2/5. knee joint anterior to the DE line: the lateral lowest return point was about 5, the average value was 10.27mm, and the range of the 95% was (8.18 to 12.36). The lowest infolding point in the inner side was about to be located approximately. The average value is 5.94mm near 10 points, and the 95% confidence interval is (5.25 to 7.6).
Conclusion: in the medial part of the calcaneus, the area of 1/3 after the AB line 1/2 AC line is the relative safety area of the percutaneous needle puncture, which is more safe. On the lateral of the calcaneus, the 3/5 is the relative safety area of the percutaneous puncture. The lowest point of return of the lateral joint capsule of the knee is about 5, and the lower 12.36mm below the articular surface is the relative safety area of the percutaneous needle puncture. The medial clearance of the knee joint is in the medial part of the knee. The minimum recurrent point of the sac is located near the 10 point. Below the articular surface is 7.6mm relative safety zone.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R687.3;R322

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